Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Friday, January 19, 2007

I couldn't have said it better myself

I definitely couldn't. Read Harlan Krumholz and colleagues on the Vioxx atrocity. They make the airtight prosecution case. The legal difficulty is that we have thousands of individual lawsuits in which each plaintiff has to persuade the jury that his or her individual heart attack was caused by Vioxx, which is generally not possible to show. What is absolutely possible to show is that a large number of injuries did result from Merck's deceptions, we just can't say exactly which ones. Unfortunately the legal system is not structured so as to assure accountability in this situation.

I'm not going to summarize Krumholz et al's brief, please read it. But here's my value added. The drug companies say that they need to have long-term exclusive marketing rights to new drugs and the opportunity to make billions because that's what motivates and pays for the very expensive process of drug development. If they couldn't make that killing, they wouldn't be able to develop the miracle drugs that save our lives. It's the magic of the market, you see, and the alternative would be socialism, which is never good because people would have to pay taxes and the oppressive institions of government would be developing new drugs, thereby depriving us of our freedom, plus which government is always inefficient.

This sort of mindless rhetoric is sufficient, in our political culture, to carry the day. It's why we have the most expensive, least efficient and least equitable health care in the world, as well as why we have so many dangerous, overpriced, misrepresented drugs on the market. In other words it's bullshit. As a society, we need to grow up and get over it.

At the root of the problem lies the intellectually corrupt academic so-called discipline of economics. College freshmen are systematically indoctrinated by economics professors in a belief system precisely analagous to the ptolemaic universe, a method of reasoning that begins with a set of entirely false assumptions (e.g. the earth is at the center of the universe and the planets revolve around it), and then erects an elaborate structure of preposterous contraptions and devices (crystal spheres, epicycles) to try to wrestle observable reality into conformity with the false explanatory basis. The properties of the economists' theoretical market are no more real than the earth's location at the center of the universe, and it's posited efficiency and benefits to consumers no more real than the crystal spheres.

Here's a quick debunking of Economics 101 using the case example of pharmaceuticals. In the ptolemaic world, transactions are characterized by perfect information. Consumers know what they are buying, they know the costs and benefits of competing products, and they make a decision that optimizes their own "utility" (a tautological concept with no actual referent in the observable universe, meaning that whatever they buy must have been the best possible choice for them). But every pill is indistinguishable from every other. They're just tiny lumps of bitter stuff. The only information we have about them is the information the seller chooses to give us. And obviously, we have no reason to trust the seller except that . . .

Aha! There is a government agency which evaluates evidence about the safety and efficacy of drugs and requires that a detailed summary of this information, approved by the government, be included with the drug as it is offered for sale. Alas, we still have a problem. The manufacturer is generating that evidence, and as we have seen, given insufficient dilligence by the government agency, the manufacturer has innumerable opportunities to slant, misrepresent, and just plain lie about it. That's the libertarian paradise, of course -- let the powerful screw the weak.

The solution? Less free enterprise, more democracy. Force the process to be transparent, public, and in the public interest. The profit motive does not work for society.